Hemorrhoids, or Something More Serious?

Medically reviewed by: Gary H. Hoffman, MD

While most people think of hemorrhoids as something you “get,” in reality everyone has hemorrhoidal tissue. This tissue is a normal part of the anatomy, and lies around the anus. In some people, though, this tissue becomes inflamed. This leads to the symptoms we think of as being caused by hemorrhoids.

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Hemorrhoid symptoms are common, but this does not mean that the symptoms are always benign, and caused only by hemorrhoids. It is always a good idea to see a doctor about hemorrhoid symptoms in order to rule out more serious causes.

The Truth Behind Hemorrhoid Symptoms

It is hard to miss the painful burning and irritating itching that most people associate with having inflamed hemorrhoids. These, however, are only the symptoms of external hemorrhoids. Internal hemorrhoids are much less likely to be symptomatic, but when symptoms do develop, they often mimic much more serious conditions.

The most common symptoms of internal hemorrhoids are also often the scariest. Although typically painless, internal hemorrhoids often come to the attention of sufferers because they cause rectal bleeding. Like all hemorrhoid symptoms, this bleeding is often intermittent.

Prolapse of the swollen anal tissue may also occur, especially while having a bowel movement. In most cases, this tissue will retract spontaneously after the bowel movement. Some people may need to use their fingers to push the tissue back. If symptoms continue to progress, the tissue may remain outside the anus, and medical attention will be required.

The Importance of a Proper Diagnosis

Most symptomatic patients who visit their doctor or colon and rectal surgeon are diagnosed with inflamed hemorrhoidal tissue. This does not mean, however, that it is OK to assume your symptoms point to hemorrhoids and therefore begin home treatment.

A hemorrhoid diagnosis can only be made after a careful exam performed by an experienced physician. This is because it can be easy to overlook other, more serious causes and attribute the symptoms to hemorrhoids.  Your proctologist, also known as a colon and rectal surgeon, is trained in the diagnosis of hemorrhoids, and of all colorectal disorders.

Anal and colorectal cancers and colitis — as well as other life-threatening diseases – may have similar symptoms to the rectal bleeding caused by internal hemorrhoids. If you have any of the following symptoms, you should be evaluated by a doctor in order to rule out serious causes before beginning hemorrhoid treatment.

  • Moderate rectal bleeding during bowel movements
  • Recurrent rectal bleeding not occurring during a bowel movement
  • A family history of colon cancer
  • A personal history of polyps
  • Prolapsed hemorrhoids
  • If you have a family history of colon cancer or are over age 40 you should see your doctor for evaluation of the recurrent rectal bleeding.

The Office Visit

Many people suffer with hemorrhoids simply because they are uncomfortable or embarrassed about sharing their symptoms with their doctor. It could lessen your anxiety about the office visit by knowing what to expect.

The appointment will begin with the doctor or a nurse taking your medical history, and asking you about the timing and severity of your symptoms. Your doctor will also need to perform a visual and manual exam, but there is no reason to feel hesitant about this examination. Your doctor is a trained professional, understands your anxiety, and will make the exam as comfortable as possible for you.

The exam typically consists of a visual inspection of the area around the anus, and possibly a digital examination by placing a gloved, lubricated finger into the anus. A small instrument known as an anoscope may also be used to allow visual inspection of internal hemorrhoids.

If the cause of the rectal bleeding is not apparent with these exams, your doctor may schedule more intensive exams to rule out polyps, cancer or other potential causes. This may include a sigmoidoscopy or colonoscopy, which both utilize flexible scopes to examine the colon. A sigmoidoscopy allows the doctor to visualize the lower half of your colon while a colonoscopy can inspect the entire colon for polyps, tumors or other issues.

Emergency Situations

In most cases, scheduling an appointment with your primary care physician or a colon and rectal specialist is sufficient in getting you the help you need to manage your hemorrhoid symptoms. Even though the symptoms are unpleasant, they can typically wait a few days until an appointment is available.

In a few situations, however, hemorrhoid symptoms may require emergency medical treatment. This includes any of the following symptoms:

  • Excessive bleeding from your rectum
  • Bleeding accompanied by weakness or lightheadedness
  • A prolapsed hemorrhoid that you cannot push back manually

If you seek emergency department care for any of these symptoms, the ER doctors will most likely address your symptoms and may conduct more in-depth testing to rule out more serious causes. You may be referred to a colon and rectal surgeon for follow up treatment.

Managing Hemorrhoids

Most people who are diagnosed with inflamed hemorrhoids experience relief with non-invasive or minimally-invasive treatment. Once you have received a diagnosis of hemorrhoids from your doctor, you can manage most of the symptoms of a flare-up at home. While your doctor may prescribe stool softeners or topical medication, you will probably also be tasked with increasing your fiber intake and using sitz baths to relieve pain, swelling and discomfort.

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